Going to the Doctor: Rideshare as Nonemergency Medical Transportation

Short abstract

The authors look closely at rideshare specifically in the nonemergency medical transportation (NEMT) context. They identify key populations for whom, and types of rides for which, NEMT could be an appropriate model, the role of rideshare in NEMT, and the policies that support such a role. The authors conclude by considering how best to support NEMT broadly and optimize rideshare within NEMT specifically through policy and process.

Abstract

Ridesharing apps have changed how people get around. Its use in nonemergency medical transportation (NEMT) is nascent but possibly growing. The authors build on existing research on health care access to describe NEMT challenges that rideshare-based NEMT (RB-NEMT) may address for those who need NEMT by identifying rider and ride types most appropriate for RB-NEMT. Population estimates for these profiles are drawn from three nationally representative sources.

The authors found that RB-NEMT could help reduce system strain and satisfy an unmet or poorly met need for on-demand cost-effective solutions within the NEMT ecosystem. Current RB-NEMT capabilities are most appropriate for individuals with medical conditions that result in the need to request rides and those who use Door2Door, Curb2Curb, or Area2Area (e.g., bus stop–to–bus stop) services. RB-NEMT is also most appropriate for in-patient and outpatient discharges, on-demand rides, requests for rides in which the scheduled mode failed to arrive, and rides requiring minimal assistance or monitoring.

The authors recommend more research on (1) RB-NEMT outcomes and the efficiency of programs targeting potential users and (2) the size, distribution, and projections for required transportation services, especially for vulnerable populations. The authors argue that policymakers should recognize that (1) transportation is a fundamental component of health care access and NEMT is a central pathway of ensuring access to vulnerable populations and (2) rideshare is a generally unique, economical, efficient, and otherwise unoccupied niche of the NEMT ecosystem, although the specific pathways to incorporating rideshare into NEMT will vary by state.

Nonemergency medical transportation (NEMT) refers to transportation to medical care that does not involve a medical emergency, usually paid for by medical insurance. As the populations accessing NEMT and the population needing NEMT increases, interest has risen in the NEMT sector to improve services, increase quality, improve timeliness, integrate technology, and reduce costs. This, coupled with the expanding popularity of rideshare services, shows the need for research into the role that rideshare-based NEMT (RB-NEMT) can play in the health care access ecosystem. This report builds on existing research on health care access to describe the challenges of NEMT that RB-NEMT can solve and those who need NEMT, including rider and ride types most appropriate for RB-NEMT. Population estimates for these profiles are drawn from three nationally representative sources.

We found that RB-NEMT can help reduce system strain and satisfy the unmet or poorly met need for on-demand cost-effective solutions within the NEMT ecosystem. Current RB-NEMT capabilities are most appropriate for individuals with medical conditions that result in the need to request rides and those who use Door2Door, Curb2Curb, or Area2Area (e.g., bus stop–to–bus stop) services. RB-NEMT is also most appropriate for inpatient and outpatient discharges, on-demand rides, requests for rides in which the scheduled mode failed to arrive, and rides requiring minimal assistance or monitoring. General recommendations include more research on (1) RB-NEMT outcomes and the efficiency of programs targeting potential users and (2) the size, distribution, and projections for required transportation services, especially for vulnerable populations, such as older adults, individuals with disabilities, and rural dwellers. For policymakers, recommendations include recognizing that (1) transportation is a fundamental component of health care access and NEMT as a central pathway of ensuring access to vulnerable populations and (2) rideshare is a generally unique, economical, efficient, and otherwise unoccupied niche of the NEMT ecosystem, although the specific pathways to incorporating rideshare into NEMT will vary by state.

As rideshare services expand in popularity—and as the populations accessing NEMT through Medicaid and Medicare Advantage increases—it becomes more pressing to explore gaps and insufficiencies in current NEMT service paradigms, the role RB-NEMT can optimally play, and the benefit of RB-NEMT playing that role in the health care access ecosystem. Rideshare is a new technology in the NEMT space, and its role is still evolving.¹